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StumbleUponAn Evolutionary Mistake?
Now, at Hypnion, Edgar hopes to find the exact location within the brain's complex chemistry where these two mechanisms mesh -- to home in even more precisely than Provigil does -- and then to find a medicine that stimulates that chemistry but not the rest of the nervous system. His goal: a drug even stronger and safer than Provigil. Such a pill could keep pilots alert during round-the-world flights. It could allow rescue workers to pull all-nighters at disaster sites. And it would surely appeal to college students, young professionals and working parents who want a quick fix for sleeplessness.But is seeking such a fix wise? There's growing evidence that doing without sleep can boost the risk of developing various diseases. "At night, our biology is organized to repair tissues that have been assaulted -- by pollution, by stress, by the workplace," says Michael Smolensky, a University of Texas environmental physiology professor. "If we take this away, we could be playing with danger."
Consider: University of Chicago researchers have discovered that when someone tries to survive on four hours of sleep a night, certain biochemical systems go awry, triggering symptoms of type-2 diabetes, memory loss and premature aging. And a recent Harvard study showed that female nurses working rotating night shifts for 30 years or more, never falling into regular sleep rhythms, have a 36 percent higher rate of breast cancer than those who never worked rotating shifts.
Given all that, some see the stay-alert pills as Band-Aids that cover up a short-term ill while ignoring -- even exacerbating -- long-term risks. What's good for one's lifestyle, these critics claim, isn't always good for one's life.
"If sleep were that unnecessary, it was a major evolutionary mistake," says Michael Wincor, associate professor of clinical pharmacy, psychiatry and behavioral sciences at the University of Southern California. "Why did we evolve to need seven or eight hours of sleep a night if all it takes is an external agent and then we don't need sleep? It's hard for me to conceive of that."
Physicians and ethicists also worry that these drugs are too tempting for many people to resist. "If people are under pressure to get ahead, and there's the possibility of working three, four, five, six days around the clock, they're going to try to get the drug, even illegally," says Audrey Chapman, an ethicist at the American Association for the Advancement of Science. Workers, she fears, will feel they must use such drugs to keep up with colleagues: "Once this starts, are we going to start a pharmacological arms race?"
That's just part of what troubles Harvard neurologist Thomas Scammel. "I've seen some truck drivers and, for reasons of lifestyle or economics or stubbornness, they refuse to get enough sleep," he says. "They say, 'I want this drug, and if I don't get it, I might get into an accident.' " Scammel says he won't prescribe modafinil under those circumstances -- though he understands why others would.
Scammel sees few cases where drugs like Provigil should be used. "We really should be trying to work with people's biology," he says, "not using drugs to patch up unhealthy societal patterns."
To Dale Edgar, that's a pipe dream. He recognizes the health risks associated with not getting enough sleep, and he doesn't think drugs like Provigil or the one he's developing are appropriate for everyone. But he believes strongly that they provide real solutions to modern problems. "Are we going to shift away from a 24-hour society?" he says. "Not a chance. The train has left the station, and it's not coming back."
No one, Edgar says, needs these drugs all the time. Those who can benefit: people with a medical need and "individuals at risk for inappropriate sleepiness, or who have responsibilities for large numbers of people, where their impairment could affect others' lives." He cites long-haul truckers, pilots, rescue workers, soldiers, or night-shift workers who could doze off while driving home.
But how many of us will take these drugs to meet deadlines, dance until sunrise or just get through another drowsy day at work -- regardless of what might be the health implications of fiddling with nature? Whatever the numbers, Edgar says, they don't undermine his primary justification for seeking a pharmaceutical wake-up call: "We can save lives."
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